Provider Demographics
NPI:1154003226
Name:WASHINGTON, HAYLEY NICOLE (EDS, PPS)
Entity type:Individual
Prefix:MISS
First Name:HAYLEY
Middle Name:NICOLE
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:EDS, PPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2285 TREEHOUSE LN # J-113
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92879-6556
Mailing Address - Country:US
Mailing Address - Phone:916-549-7423
Mailing Address - Fax:
Practice Address - Street 1:2285 TREEHOUSE LN # J-113
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92879-6556
Practice Address - Country:US
Practice Address - Phone:916-549-7423
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-07
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA190236896103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool